Silent killer
The condition and its associated complications like stroke, heart disease, blindness and renal failure are rapidly turning diabetes into a health catastrophe, reportsAnjana Jha
The American Diabetes Association claims that a person is diagnosed with diabetes every 21 seconds. And the World Health Organisation (WHO) tells us that the year 2025 will see 300 million people across the world affected by diabetes. Currently, 20.8 million suffer from diabetes in the US-- approximately 7 per cent of its population. TIME magazine predicts that the numbers will double by 2025.
More frightening, the disease is expected to be three times worse in Africa, the eastern Mediterranean, the Middle East, and Southeast Asia. Already achieving the dubious distinction of becoming the world's diabetes capital, India has an estimated 41 million diabetics. Expected to increase to 57 million by 2025, the figure could touch 79 million in 2030. The growing silver population is one of the main reasons behind this surge. Though the disease starts at a much later stage in developed countries, the majority of diabetics in India are in the 45-65 age group. The implications of this disease are enormous.
Though diabetes causes only about 5 per cent of all annual deaths globally [WHO], it contributes to the development of potentially life-threatening conditions including heart disease, stroke, hypertension, blindness and renal disease.
UNDERSTANDING DIABETES
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No matter how unbelievable it may sound, there was no treatment for diabetes before 1955. Research witnessed a major turn with the manufacture of oral hypoglycaemic drugs. It took another four years before the disease and its types were recognised. "One of the most common medical disorders, diabetes occurs owing to the malfunction of the body's ability to use the energy in food," says Dr Suhas Gopal Erande, consultant diabetologist at Akshay Hospital & Diabetes Speciality Centre in Pune.
A hormone called insulin helps glucose in the blood stream to enter the body cells. In other words, insulin serves as the key to open cell doors and remove sugar from the blood. The body's inability to respond to the insulin produced by the body (insulin resistance) or make enough insulin (insulin deficiency) increases the sugar level in the blood resulting in diabetes.
Insulin is a natural hormone made by beta cells in the pancreas that controls the level of sugar glucose in the blood. It enables the cells to take glucose from the bloodstream and use it for production of energy, or preserve it in the liver in the form of glycogen. Diabetes is mainly classified as type 1 and type 2. An autoimmune reaction, type 1 diabetes results from inadequate production of insulin -- such diabetics are dependent on external insulin. "Though type 1 can occur at any age, it is more common in children and young adults and accounts for less than 3 per cent of all diabetes cases in India," informs Dr Erande. It is also known as insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes.
The incidence of type 2 or non-insulin-dependent diabetes mellitus (NIDDM) has increased in recent decades and accounts for over 90 per cent of diabetes cases. Though an adult-onset condition with patients mostly over 40, it is being increasingly detected in children, adolescents and younger adults. Patients respond to oral medication initially but may soon require insulin for better management.
Gestational diabetes develops in about two per cent of all pregnant women every year. Usually a temporary condition, it disappears after delivery but leaves the woman at higher risk of type 2 diabetes in later years. Incidence of secondary and nutrition-related diabetes mellitus is comparatively insignificant.
First discovered in the 1920s, insulin derived from cattle (bovine) and pigs (porcine) has been highly purified since the 1970s. After the introduction of genetically produced 'human' insulin in 1982, the vast majority of patients requiring insulin treatment are prescribed human insulin. "It is biosynthetic insulin made by using e-coli bacteria," explains Dr Debasish Maji, professor and head of medicine at Vivekananda Institute of Medical Sciences in Kolkata. "Though it has no allergic reactions, anti- body formation is still evident insubstantial number of users (55 per cent) of human insulin. However, the percentage is much lower compared to that in animal-derived insulin. Costing significantly more than porcine insulin when it first appeared in Indian markets around 1987, the comparable price of human insulin has now resulted in phasing out both bovine and porcine insulin completely. Today, 10 ml vial of human insulin costs around Rs 120 to Rs 130."
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